Today's top occupational hazard?

Tuesday

Oct 15, 2013 at 2:00 AM

Repetitive use of hands has escorted mankind throughout history — from striking rocks together to coax a spark, to scrubbing clothes at the riverbank, to harvesting crops, to milking cows, to wielding a hammer, to using a computer.

Deborah J. Botti

Repetitive use of hands has escorted mankind throughout history — from striking rocks together to coax a spark, to scrubbing clothes at the riverbank, to harvesting crops, to milking cows, to wielding a hammer, to using a computer.

The U.S. Department of Labor and Statistics indicates carpal tunnel syndrome — a painful progressive condition caused by compression of a key nerve in the wrist, resulting in pain, numbness, tingling, burning or itching in the hands — affects more than 8 million Americans and accounts for about half of all work-related injuries.

So is there more injury today? That's hard to say, says Dr. Samir Sodha, an orthopedic surgeon with Crystal Run Healthcare and the Department of Orthopedic Hand Surgery at Orange Regional Medical Center.

For the past year, he and his partners, Dr. Vipul Patel and Dr. Dimitrios Christoforou, have also manned the new Hand Center at Orange Regional Medical Center, where more than 250 cases of hand trauma have been handled.

"There's better detection," Sodha says. "Before, people were told, 'Just shake it out.' Today, we can do something."

Here are the four most common complaints patients present with, as the trio discussed at a recent conference at Orange Regional Medical Center.

Sodha likens carpal tunnel syndrome to driving through the Lincoln Tunnel at rush hour, when scores of cars are jammed into the structure. Instead of cars, it's the median nerve and tendons, which help bend the fingers, which run through the tunnel from the wrist to the hand.

The key carpal tunnel symptom is being woken up at night by numbness and tingling in the hand, a numbness that typically extends to the thumb, index and long finger. It can also manifest in the daytime while driving or in certain professions, such as when a hairdresser is using a blow dryer, a chef a knife, or a data processor a keyboard.

Sodha says that while patients span the age spectrum, most are older than 50. Those who are younger usually have a family history or have experienced trauma. "The first line of defense is splinting the hand during the night and while engaging in that repetitive motion," says Sodha. Over-the-counter anti-inflammatories can also be taken.

"If someone has mild to moderate carpal tunnel syndrome and is not ready for surgery, cortisone injections can be effective," he says. "They last anywhere from three months to a year and have a low risk because the steroid stays in the hand." However, Sodha cautions that cortisone injections can raise blood sugar in diabetics.

Sodha says among himself, Patel and Christoforou, they perform 10-15 surgeries a week, with only a 2 percent to 5 percent chance of recurrence.

Basal thumb arthritis causes pain at the base of the thumb when that pinch mechanism is engaged, such as in turning a key or opening a jar. As it progresses, the area can be sore all the time and sometimes swells. "It's an important joint, and often the first one to wear out," says Sodha. "It's extremely common, and more common in women than in men."

Sodha says there is a link between one of the pregnancy hormones, elastin — which relaxes ligaments to accommodate pregnancy and allow for delivery — and basal thumb arthritis. The elastin can also loosen thumb ligaments, resulting in a degrading of cartilage that cushions the bones, sometimes sending women in their 40s to their doctors. "Men tend to get it later in life — but have more severe findings when they do get it," he says, citing the longtime wear and tear that mechanics, for example, might suffer with.

Again, anti-inflammatories, followed by cortisone shots and custom thumb braces are part of the first-line-of defense arsenal. Surgery, which takes about 45 minutes to an hour, is a subsequent option, and the techniques have evolved considerably.

Sodha says he experienced this condition, a form of tendinitis where a finger locks in a bent position because the tendon gets stuck in its sleeve. He attributes his to overusing his computer's mouse — specifically, repetitive clicking thousands of times while engaged in a particular project.

Although a definitive cause is unclear, diabetes, thyroid issues and inflammatory conditions can predispose one to trigger fingers, which can involve any finger, but the thumb, ring or long finger are most commonly involved.

The same first-line course of treatment exists: Anti-inflammatories, stopping the activity, splinting the finger and cortisone injections. As with carpal tunnel surgery, it's a quick — often no more than five minutes — procedure that involves a small cut at the base of the finger to release the sleeve thereby freeing the tendon. The success rate, too, is also similar — 95 percent to 98 percent.

Named after its Swiss discoverer, de Quervain's syndrome is categorized by a searing pain from the thumb down the side of the wrist that accompanies certain motions.

If resting, splinting, cortisone injections and anti-inflammatories don't work, then a surgical release is probably warranted. "The five-to-10-minute surgery, which 20 years ago required general anesthesia, is now quite simple and can be done with the injection of some numbing medication with sedation," says Sodha.